An Embarrassing Allergy

Edgar Bowler relies on his much younger wife, who sees one of my partners, to help him keep track of his appointments and drive him to the office. Both of them have multiple medical problems and between them they take well over a dozen different medications. She usually handles their prescription refills and pill minders. Some of their medications are quite expensive and not all of them are covered by their insurance, so our office sometimes helps them out with samples.

Recently, Jane Bowler had eye surgery and Edgar had to step in with the help of his son-in-law, Jonathan, and take care of their medications. They came in to pick up a bag of several kinds of medication samples we had saved for them.

A few days ago, Edgar made an urgent appointment for hives. He was literally covered with them. Fortunately, he didn’t have any trouble with his breathing, but I did prescribe both steroids and antihistamines for him. At first, he had no idea what had caused the hives, but as I went down the usual list of considerations, he exclaimed:

“New medications, yes, there was a new one in the bag Jonathan and I picked up a while ago, that might have been it!”

“But I haven’t prescribed anything new for you,” I protested.

“You didn’t?”

“I think we need to take a look at those pills, Edgar. Could you bring them in for us to look at later on?”

Edgar left with his allergy medication prescriptions. Later the same day he returned with all his pills, neatly laid out in his two-week pill-minder.

The ones that seemed to have caused his hives were off-white, oblong, and imprinted with “LILLY 4165”.

The offending drug turned out to be Evista, a selective estrogen receptor modulator, used occasionally for postmenopausal women such as his wife, Jane, and never for men.

How does one explain that on Edgar’s list of allergies in his medical record?